Integrative Breastfeeding Consultant- Candy Scarbrough

01/08/2025

Baby’s first snow is so exciting! Making sure you are ready to feed is important, in the case of inability to travel or loss of power/water.

If you are currently exclusively feeding at the breast, be sure to have plenty of high protein snacks and electrolytes on hand.

If you rely on an electric pump either partially or full time,
*Have an extra power source in the event of power outage.
*A manual pump will always be a good tool to have on hand
*Know hand expression…know hand expression…and know hand expression again
*Plan to have an alternative water source for cleaning pump parts/bottles
*Have a backup plan for storing extra milk collected. (Snow or outside is a great backup temporarily)
*Have a plan for any milk currently stored in your freezer

If you are currently using formula as a primary source of food
*Have 7 days of storage if possible
*Ready made is the best option if possible
*Have a backup water source to make formula
*Have a backup method for warming milk

Should power go out, remember the warmest place for baby is on your skin.

I will post more specific guidelines and tips for troubleshooting in The Breastaurant today. If you aren’t a member and would like to be added, comment below or send a pm.

12/08/2023

We are now accepting new clients due Jan-Feb for prenatal, in home consultations. One on one consults are intended to help you begin your feeding journey with a plan individualized for you. Clients established prior to delivery have the advantage of prebooking standing appointments. Most commercial insurance will cover multiple home visits at 100%! To get your approval started and book your personal prenatal consultation (865) 934-9679

11/28/2023

It's winter time, which means dryer air from heating and more antibiotic use for sickness. Moms CAN get yeast on ni***es. It isn't always the answer for soreness, but it can absolutely happen.

While a regular antifungal/jock itch cream can work to get rid of yeast, it contains alcohol. Alcohol + dry air is gonna promote cracking. I never recommend using an OTC antifungal. There are so many other options.

**Nystatin oral suspension also has

06/27/2023

"I think a lot of women think that it is all or nothing. And so when they try all and it's too hard, they totally quit instead of backing off a little bit. But that's where you need that individualized support to be able to say, what are your goals?" Lehman said.

❤️❤️❤️

Only about a quarter of women meet breastfeeding recommendations, research shows.

12/22/2022

For the mamas who have worked tirelessly to build a stash in your freezer, READ THIS. ❄️❄️❄️

If the power goes out and you have a freezer full of frozen pumped milk, don't panic. Here's how to salvage some of your milk.

07/24/2022

This is so perfectly said. If you've worked with me, I think you know this is what I mean when I say, "I'm conservative when it comes to oral procedures".

Sometimes a minimal clip is necessary early. Timing is important. The reason a procedure is recommended is important. Correction isn't always an instant fix and usually requires a commitment to a plan that involves weeks of oral exercises and sometimes bodywork to help things fall into place.

"It's a fairly straight forward procedure in office, but it's not nothing". Every mom and baby should be assessed and guided with a plan specific to their needs.

When should you consider doing a frenotomy?

I get asked this question all the time. I have some fairly simple responses that I hope make sense.

1) I recommend a frenotomy when the symptoms associated with NOT doing the frenotomy are worse. Keep in mind that this includes any aftercare wound management. In my hands, doing a frenotomy on an infant takes about 10-15 seconds. But because I demand a wound aftercare protocol that is intensive, that has to be considered as a very important piece of the puzzle. How does this translate? Well, if a tongue tie is identified but overall feeding symptoms aren’t severe, it’s not unreasonable to keep an eye on things rather than jumping to a procedure.

2) I recommend a frenotomy when non-surgical options have failed. Infant feeding problems are multifactorial and can include things that have nothing to do with a tongue tie. This is why I demand the evaluation and treatment by an IBCLC before I even allow an appointment to be made. In most cases, surgery for tongue tie should not be the first option (the exception is a baby with an obvious anterior tongue tie).

3) I do NOT recommend a procedure to prevent future problems (again, the exception being an obvious anterior tongue tie). To put a family through an extensive aftercare protocol for a symptom that hasn’t shown up yet OR will never show up makes no sense at all. The existing scientific literature does not support prophylactic treatment of tongue ties.

4) If I am treating an obvious anterior tongue tie and symptoms aren’t horrible, I will consider doing a simple anterior release (like most people do as their standard/only option). When I do this, there’s no wound so there’s no aftercare. That being said, I’m leaving that baby with a residual posterior tongue tie. I inform parents of this anatomy because some babies need the remainder released to improve feeding in infancy. If the conservative release helps contemporary feeding problems, I still tell the parents to be on the lookout for possible future issues and to return for reevaluation.

I hope this helps!

06/28/2022

Bigmouth Strikes Again

Fair warning: I’m not a lactation consultant. I’m open to challenges on this post when it comes to latch mechanics on the breast, but I want to share my observations and experiences.

I find that too many people are worried about the upper lip flanging or not flanging. Flanging = “yay!” and not flanging = “Boo!” I don’t think that’s an accurate assessment. Here’s what I think instead:

1) The upper lip doesn’t have to fl**ge for the latch to be good. It can definitely be neutral on the breast for the latch to be appropriate. I do think that an upper lip that is pursed in is not normal. It indicates that the baby is using the lip inappropriately.
2) A pursed in upper lip does NOT mean lip tie. It means lip use.
3) The lower lip should not be an active source of obtaining the latch. If the baby is using the lower lip, something’s wrong. Lower lip tie doesn’t affect breastfeeding and should never be done in infants.
4) I’ve definitely seen babies with perfectly fl**ged out lips but their mouths are so closed that it’s almost like the fishy lips face you can make - super shallow and maladaptive.

So what should we focus on instead when evaluating a baby’s latch? To me, the #1 focus should be on the mouth size during the latch.
1) If you’re telling the mom to “wait until the baby cries and opens widely and then shove your breast in”, you should be asking yourself why the baby isn’t opening the mouth widely.
2) There needs to be a seal on the breast before suction can occur. This isn’t rocket science. What you have to do is to figure out whether the seal is being made with the lips (small mouth) or the tongue (wide mouth). If the baby can’t keep the seal with a wide mouth, you have to ask why. Tongue tie is a leading cause.

In the end, we have to understand that the tongue needs to be the motor of the latch. It needs to form the seal so the mouth can be open widely to achieve that deeper, comfortable latch.

05/13/2022

I don't have a hungry baby or a hungry grand tonight, and for that I'm thankful. Yet I have been awake and so so burdened for the moms who do not have breastmilk, and are on their last can of formula, not knowing what is next. My colleagues and I are working desperately to help those we can. I've ended my vacation 2 days early to add appointments this weekend, and I know they are working more hours.

We can help with relactation for some, and I'd encourage anyone, who wishes to try, to reach out. That isn't the answer for TODAY or even next week, but it is something. Hopefully how to feed our babies will not be a long term struggle, but my best advice to anyone planning to breastfeed or currently struggling to breastfeed is to get help now. Tell your friends who need help to get help early. Getting help in the first 2 weeks after birth, at home, can make all the difference in the world in breastfeeding longevity, 4-6 weeks postpartum is still a great window. ANY time can be helpful.

I am thankful to our wonderful hospital and home birth IBCLCs and counselors for getting moms off to a great start. Thank you to those who are able to provide outpatient services. Sometimes problems do not arise until day 4/5. Many insurance policies will cover in home help at 100%. Tenncare will not. Raise your voice about this! Everyone deserves help.

My cell is 865 934 9679

In network IBCLCs:
Kristin Williams
Jade Potter

You can find a list of all available breastfeeding resources here

https://www.knoxcounty.org/health/breastfeeding.php

This guide for mothers lists resources for breastfeeding consultations, prenatal breastfeeding classes, breastfeeding support groups, regional WIC breastfeeding peer counselor services and breast pump rentals. Click here to view online.

03/13/2022

We have some ANAZING pediatricians here in East TN! Thankful

How much does your pediatrician know about breastfeeding?

I'm going to review an important paper published in 2011 by Osband and colleagues: https://pubmed.ncbi.nlm.nih.gov/21272827/

The purpose of this post is NOT to bash primary care doctors. Instead, I want to explain to everyone why I require an evaluation by an IBCLC to be able to schedule an appointment with me for consideration of a tongue/lip tie release. I put a tremendous amount of value on their assessment.

This paper surveyed 132 pediatric residency programs across the US to determine the amount of breastfeeding education provided. On average, a pediatric resident gets 9 *hours* of total education on breastfeeding during their entire training (3 hours per year). The attached graph shows the breakdown of those hours and demonstrate how little time they spend with the actual breastfeeding experts (lactation consultants). In contrast, an IBCLC can spend more than 2000 hours during their clinical training.

What about ENTs and dentists? How many hours do they get during training? ZERO.

So what's the take home message? If you have a baby with breastfeeding issues or compensations that are causing maternal symptoms, your first stop needs to be an IBCLC. Should you ever do a procedure because an ENT or dentist says you should? No, not without IBCLC involvement first. And if you're a medical professional taking care of these dyads, you need to change your mindset. All too often, IBCLCs aren't respected, their notes aren't read, their voices are silenced by people who don't listen to people without a medical or dental degree behind their names.

03/02/2022

Human babies are different than cow babies

If you are a primary care doctor and you are focusing only on infant weight gain, and you ignore other symptoms of breast-feeding or bottlefeeding, you are doing a disservice to your families. Focusing just on the weight gain is what a farmer would do for a baby cow. Focusing on just weight gain for a human can ignore the detrimental effects of air ingestion, ni**le pain, ni**le trauma, a very fussy baby etc.

Be a doctor. Even farmers care for the welfare and quality of life for their livestock. We should do the same for babies.

02/06/2022

Fad? Dare I say not!

This picture is taken from the Obladen 2010 paper discussing the history of tongue tie. The pictures are from woodcuts by Fabricius and Scultetus in 1620 and 1666 respectively. In 500 years, little has changed - the instrument used to pick up the tongue looks identical to what is depicted here AND the babies are giving these surgeons the same look they give me.

08/19/2021

Just a little graphic I love. Great analogy. All breastfeeding relationships look different ☺️